Article

The Response of Persons With Chronic Nonspecific Low Back Pain to Three Different Volumes of Periodized Musculoskeletal Rehabilitation

April 2011
The Journal of Strength and Conditioning Research 25(4):1052-64

Source
PubMed

Authors:

University of Regina

Chronic nonspecific low back pain (CLBP) is a common musculoskeletal health issue associated with pain and disability reduced quality of life (QoL). Pain initiates a fear-avoidance cycle, which needs to be broken if rehabilitation is to work. To break this cycle, exercise must be gradual and focused on strengthening the weakened musculature. Recently, periodized resistance training was effectively used as a musculoskeletal rehabilitation for adults with CLBP. The purpose of this study was to determine if the volume of periodized musculoskeletal rehabilitation (PMR) influences strength, pain, disability, and QoL in untrained persons. Subjects (n = 240) were age and sex matched, with attempts made to match on strength and pain, and randomly assigned to groups after baseline testing: (a) 4 days per week (4D; n = 60), (b) 3 days per week (3D; n = 60) (c), 2 days per week (2D; n = 60) training volume or control (C; n = 60) with no training. The PMR program progressively overloaded muscle groups, with mean training volumes of 4D (1,563 repetitions [reps] per week), 3D (1,344 reps per week), and 2D (564 reps per week). Three weeks of familiarization and 13 weeks of PMR were employed. The 4D training volume significantly (p ≤ 0.05) outperformed all other training volumes by weeks 9 and 13. However, all training volumes made significant (p ≤ 0.05) improvements in strength, pain, disability, and QoL across time. The effect sizes (ESs) associated with the group means of the outcome measures ranged from moderate to strong, with the 4D training volume consistently demonstrating the largest ESs. The 4D training volume is most effective at treating CLBP. Periodization cannot only be applied to athlete training but also to the rehabilitation setting.

Do people with musculoskeletal pain differ from healthy cohorts in terms of global measures of strength? A systematic review and meta-analysis

Article

Full-text available

Sep 2022
CLIN REHABIL

Objective It is currently unknown if people with musculoskeletal pain display different multi-joint strength capacities than healthy cohorts. The aim was to investigate whether people with musculoskeletal pain show differences in global measures of strength in comparison to healthy cohorts. Data sources A systematic review was conducted using three databases (Medline, CINAHL and SPORTDiscus) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Review methods Studies involving participants with painful musculoskeletal conditions and multi-joint strength assessment measured at baseline were included. A meta-analysis was also performed to compute standardized mean differences (± 95% confidence intervals), using Hedge's g, and examined the differences in multi-joint strength at baseline between participants with painful musculoskeletal conditions and healthy participants. Results In total, 5043 articles were identified, of which 20 articles met the inclusion criteria and were included in the qualitative analysis. The available evidence revealed that multi-joint strength values were limited to knee osteoarthritis, fibromyalgia, chronic low back pain, and rheumatoid arthritis. Only four studies were included in the quantitative synthesis and revealed that only small differences in both chest press ( g = −0.34, 95% CI [−0.64, −0.03]) and leg press ( g = −0.25, 95% CI [−0.49, −0.02]) existed between adult women with fibromyalgia and active community women. Conclusion There is a paucity of multi-joint strength values in participants with musculoskeletal pain. Quantitative comparison with healthy cohorts was limited, except for those with fibromyalgia. Adult women with fibromyalgia displayed reduced multi-joint strength values in comparison to active community women.

The Influence of Exercise Intensity on Psychosocial Outcomes in Musculoskeletal Disorders: A Systematic Review

Article

Mar 2022

Context Psychosocial parameters play an important role in the onset and persistence of chronic musculoskeletal disorders (CMSDs). Exercise therapy is a valuable therapeutic modality as part of CMSD rehabilitation. Hereby, exercise intensity is an important factor regarding changes in pain and disability in multiple CMSDs. However, the impact of exercise intensity on psychosocial outcomes remains poorly explored. Objective To identify the effects of different modes of exercise intensity on psychosocial outcomes in persons with CMSDs. Data Sources A systematic search was conducted up to November 2020 using the following databases: PubMed/MEDline, PEDro, Cochrane Library, and Web of Science. Study Selection Studies reporting exercise therapy in CMSDs with a predefined display of exercise intensity and an evaluation of at least 1 psychosocial outcome were included. Study Design Systematic review. Level of Evidence Level 2a. Data Extraction Data regarding demographics, exercise intensity, and psychosocial outcomes were included in a descriptive analysis. Methodological quality was assessed using the PEDro scale and Critical Appraisal Skills Programme (CASP) checklist. Results A total of 22 studies, involving 985 participants (with fibromyalgia, chronic low back pain, knee osteoarthritis, psoriatic arthritis, and axial spondyloarthritis) were included (mean PEDro score = 5.77/10). The most common psychosocial outcomes were quality of life (QoL) (n = 15), depression (n = 10), and anxiety (n = 9). QoL improved at any exercise intensity in persons with fibromyalgia. However, persons with fibromyalgia benefit more from exercising at low to moderate intensity regarding anxiety and depression. In contrast, persons with chronic low back pain benefit more from exercising at a higher intensity regarding QoL, anxiety, and depression. Other CMSDs only showed limited or conflicting results regarding the value of certain exercise intensities. Conclusion Psychosocial outcomes are influenced by the intensity of exercise therapy in fibromyalgia and chronic low back pain, but effects differ across other CMSDs. Future research is necessary to determine the exercise intensity that yields optimal exercise therapy outcomes in specific CMSDs.

Randomized Trial of General Strength and Conditioning Versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes

Article

Full-text available

Jun 2020

Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome; however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6‑month intervention of general strength and conditioning (GSC; n = 20; up to 52 sessions) or motor control exercise plus manual therapy (MCMT; n =20; up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio‑respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, p = 0.003), but not at 6-month follow‑up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm; p = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm; p < 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between‑group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s; p = 0.004) and flexion endurance (51.5 (20.5, 82.6) s; p = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg; p = 0.001) and endurance (9.1 (1.7, 16.4) reps; p = 0.015) compared to MCMT. GSC reduced disability (−5.7 (‑11.2, −0.2) pts; p = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts; p < 0.001) compared to MCMT at 6‑month follow-up. Multifidus volume increased within-group for GSC (p = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more diverse range of treatment effects compared to MCMT.

Periodized resistance training for persistent non-specific low back pain: a mixed methods feasibility study

Article

Full-text available

May 2020

Background: We investigated the feasibility of a 16-week supervised heavy resistance training program with weekly undulating periodization for individuals with persistent non-specific low-back pain (LBP). Methods: Twenty-five adults with persistent non-specific LBP participated in this mixed methods feasibility study. Participants trained a whole-body program consisting of squat, bench press, deadlift and pendlay row two times per week for 16 weeks. We assessed pain intensity, pain-related disability, pain self-efficacy and one-repetition maximum strength at baseline, 8 weeks and 16 weeks. Three focus group interviews were conducted at the end of the program. Linear mixed models were used to assess changes in outcomes, and the qualitative data was assessed using systematic text condensation. Results: We observed clinically meaningful reductions in pain intensity after 8 and 16 weeks of training. The mean difference on the numeric pain rating scale (0-10) in the last 2 weeks from baseline to 8 weeks was 2.6 (95% CI: 1.8-3.6) and from baseline to 16 weeks 3.4 (95% CI: 2.5-4.4). In addition, there were improvements in pain-related disability (3.9, 95% CI: 2.3-5.5), pain self-efficacy (7.7, 95% CI: 5.4-10.1) and muscle strength. In the focus group interviews, participants talked about challenges regarding technique, the importance of supervision and the advantages of periodizing the training. Perceived benefits were improved pain, daily functioning, energy level and sleep, and changes in views on physical activity. Conclusion: Periodized resistance training with weekly undulating periodization is a feasible training method for this group of individuals with persistent non-specific LBP. A randomized clinical trial should assess the efficacy of such an intervention. Trial registration: clinicaltrials.gov/ Identifier - NCT04284982, Registered on February 24th 2020.

Periodized resistance training for persistent non-specific low back pain: A mixed methods feasibility study

Preprint

Full-text available

Mar 2020

Background: We investigated the feasibility of a 16-week supervised heavy resistance training program with weekly undulating periodization for individuals with persistent non-specific low-back pain (LBP). Methods: Twenty-five adults with persistent non-specific LBP participated in this mixed methods feasibility study. Participants trained a whole-body program consisting of squat, bench press, deadlift and pendlay row two times per week for 16 weeks. We assessed pain intensity, pain-related disability, pain self-efficacy and one-repetition maximum strength at baseline, 8 weeks and 16 weeks. Three focus group interviews were conducted at the end of the program. Linear mixed models were used to assess changes in outcomes, and the qualitative data was assessed using systematic text condensation. Results: We observed clinically meaningful reductions in pain intensity after 8 and 16 weeks of training. The mean difference on the numeric pain rating scale (0-10) in the last two weeks from baseline to 8 weeks was 2.6 (95% CI: 1.8-3.6) and from baseline to 16 weeks 3.4 (95% CI: 2.5-4.4). In addition, there were improvements in pain-related disability (3.9, 95% CI: 2.3-5.5), pain self-efficacy (7.7, 95% CI: 5.4-10.1) and muscle strength. In the focus group interviews, participants talked about challenges regarding technique, the importance of supervision and the advantages of periodizing the training. Perceived benefits were improved pain, daily functioning, energy level and sleep, and changes in views on physical activity. Conclusion: Periodized resistance training with weekly undulating periodization is a feasible training method for this group of individuals with persistent non-specific LBP. A randomized clinical trial should assess the efficacy of such an intervention.

Periodized resistance training for persistent non-specific low back pain: A mixed methods feasibility study

Preprint

Full-text available

Mar 2020

Background: We investigated the feasibility of a 16-week supervised heavy resistance training program with weekly undulating periodization for individuals with persistent non-specific low-back pain (LBP). Methods: Twenty-five adults with persistent non-specific LBP participated in this mixed methods feasibility study. Participants trained a whole-body program consisting of squat, bench press, deadlift and pendlay row two times per week for 16 weeks. We assessed pain intensity, pain-related disability, pain self-efficacy and one-repetition maximum strength at baseline, 8 weeks and 16 weeks. Three focus group interviews were conducted at the end of the program. Linear mixed models were used to assess changes in outcomes, and the qualitative data was assessed using systematic text condensation. Results: We observed clinically meaningful reductions in pain intensity after 8 and 16 weeks of training. The mean difference on the numeric pain rating scale (0-10) in the last two weeks from baseline to 8 weeks was 2.6 (95% CI: 1.8-3.6) and from baseline to 16 weeks 3.4 (95% CI: 2.5-4.4). In addition, there were improvements in pain-related disability (3.9, 95% CI: 2.3-5.5), pain self-efficacy (7.7, 95% CI: 5.4-10.1) and muscle strength. In the focus group interviews, participants talked about challenges regarding technique, the importance of supervision and the advantages of periodizing the training. Perceived benefits were improved pain, daily functioning, energy level and sleep, and changes in views on physical activity. Conclusion: Periodized resistance training with weekly undulating periodization is a feasible training method for this group of individuals with persistent non-specific LBP. A randomized clinical trial should assess the efficacy of such an intervention. Trial registration clinicaltrials.gov/ Identifier – NCT04284982, Registered on February 24th 2020.

Periodized resistance training for persistent non-specific low back pain: A mixed methods feasibility study

Preprint

Full-text available

Mar 2020

Background We investigated the feasibility of a 16-week supervised heavy resistance training program with weekly undulating periodization for individuals with persistent non-specific low-back pain (LBP). Methods Twenty-five adults with persistent non-specific LBP participated in this mixed methods feasibility study. Participants trained a whole-body program consisting of squat, bench press, deadlift and pendlay row two times per week for 16 weeks. We assessed pain intensity, pain-related disability, pain self-efficacy and one-repetition maximum strength at baseline, 8 weeks and 16 weeks. Three focus group interviews were conducted at the end of the program. Linear mixed models were used to assess changes in outcomes, and the qualitative data was assessed using systematic text condensation. Results We observed clinically meaningful reductions in pain intensity after 8 and 16 weeks of training. The mean difference on the numeric pain rating scale (0-10) in the last two weeks from baseline to 8 weeks was 2.6 (95% CI: 1.8-3.6) and from baseline to 16 weeks 3.4 (95% CI: 2.5-4.4). In addition, there were improvements in pain-related disability (3.9, 95% CI: 2.3-5.5), pain self-efficacy (7.7, 95% CI: 5.4-10.1) and muscle strength. In the focus group interviews, participants talked about challenges regarding technique, the importance of supervision and the advantages of periodizing the training. Perceived benefits were improved pain, daily functioning, energy level and sleep, and changes in views on physical activity. Conclusion Periodized resistance training with weekly undulating periodization is a feasible training method for this group of individuals with persistent non-specific LBP. A randomized clinical trial should assess the efficacy of such an intervention.

The use of periodized exercise prescription in rehabilitation: a systematic scoping review of literature

Article

Apr 2018

Objective: To describe the use of periodized exercise prescription with patients in the context of rehabilitation. Data source: The following databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, CINAHL, ScienceDirect, PEDro, Web of Science, SPORTDiscus, SAGE and Google Scholar. Databases were searched from inception to March 2018. Results: The literature search yielded 1772 articles with 1755 being excluded leaving 17 articles in total for the full review. Methodological quality and internal validity of the included papers were lacking. The included studies failed to indicate in which phase rehabilitation had occurred. Programme structure relating to the use of a familiarization phase, sequencing of exercises and structuring of specific phases (i.e. macrocycle, mesocycle and microcycle) was not present and lacked consistency across the board. Conclusion: Periodization models of exercise prescription are being used within a variety of population groups in the rehabilitation setting. Integration of periodization principles into a rehabilitation programme still however remains a challenge. Although there is a lack of consistency with regard to the structure and implementation of a periodized model of exercise prescription in the rehabilitation context, it seems to be an alternative way in which to prescribe exercise within the rehabilitation setting.

Concepts and updates on the use of periodization and training load I – Block periodization

Article

Full-text available

Sep 2017

ABSTRACT: Training when systematized and controlled is termed "periodization," this definition is characterized by a logical method of planning and developing a training program using short or long cycles of training to improve capacity specific to the needs of athletes. The periodization should be systematized and controlled, for this, some tools were currently developed to minimize possible prescription errors, predict performance and avoid excessive training loads. The following research strategy was used in PubMed, which searched for words and their position in the manuscript, being: training / training load, External load, internal load or training load and periodization of training Through the analysis of the state of the art in the periodization and training load, it was possible to affirm that the training in blocks seems to be more effective in improving the aptitude of elite athletes, whereas the traditional training proves to be a good tool for the introduction of special populations In a training plan.

Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals

Article

Full-text available

Jun 2016

Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. Level of evidence: V.

Exercise Program Guidelines for Persons With Chronic Nonspecific Low Back Pain

Article

Feb 2013

CHRONIC NONSPECIFIC LOW BACK PAIN (CNSLBP) CAN BE A DEBILITATING CONDITION. THE MAJORITY OF U.S. CITIZENS WILL EXPERIENCE LOW BACK PAIN THAT MAY BECOME CHRONIC AT SOME TIME IN THEIR LIVES. HOWEVER, EXERCISE TRAINING HAS MANY BENEFITS AND CAN BE WELL TOLERATED WITH SOME MODIFICATIONS. THIS COLUMN WILL DISCUSS EXERCISE PROGRAMMING FOR PERSONS WITH CNSLBP.

Chronic Nonspecific Low Back Pain and Exercise

Article

Feb 2013

CHRONIC NONSPECIFIC LOW BACK PAIN (CNSLBP) IS A COMMON MUSCULOSKELETAL CONDITION OFTEN RESULTING IN PHYSICAL INACTIVITY AND DISABILITY. EXERCISE IS BENEFICIAL TO IMPROVE HEALTH-RELATED QUALITY OF LIFE FOR PERSONS WHO SUFFER FROM CNSLBP. THIS COLUMN DISCUSSES CNSLBP EPIDEMIOLOGY AND ETIOLOGY AS WELL AS EXERCISE EFFECTS, BENEFITS, AND GOALS FOR PERSONS WITH CNSLBP.

EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol

Article

Full-text available

Jan 2021
BMC MUSCULOSKEL DIS

Background Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings. Methods/design We will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist ( n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants’ opinions and any barriers encountered throughout the trial. Discussion The findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas. Trial registration This study was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12618001494224 ) registered 09.05.2018.

Potential lower extremity amputation-induced mechanisms of chronic low back pain: role for focused resistance exercise

Article

Full-text available

May 2019

Purpose: Approximately 185 000 individuals undergo limb amputations every year. Of this population, 40% experience lower extremity amputations. A common musculoskeletal condition that develops after amputation is chronic low back pain (LBP). LBP may be a consequence of one or combined mechanical factors including muscle atrophy, strength loss, level of amputation, kinematic traits of movement, mechanical loading and forces, prosthetic design/use and leg length discrepancy. Secondary consequences of LBP may collectively include the dependence of pain medications, impaired physical function, and diminished quality of life (QOL). Methods: A systematic literature search using PubMed was conducted to identify articles of low back pain in lower limb amputees. Results: Long-term interventions are needed to reduce the incidence, prevalence, and secondary impacts of LBP in amputees. Resistance exercise has strong potential to help correct mechanical deficits in lower limb amputees. Resistance exercise adaptations that can be beneficial for this population include improved neuromuscular control, increases in lumbar and core muscle strength cross-sectional area, and improved gait motion parameters. Conclusions: This narrative review provides an overview of the key mechanical and physiological factors which may contribute to chronic LBP in amputees, and discusses the use of resistance exercise training to combat these mechanical factors to improve pain symptoms. • IMPLICATIONS FOR REHABILITATION • Low back pain is more prevalent in the amputee population compared to the general population. • Low back pain may be due several mechanical factors that develop after a unilateral amputation. • Lower extremity amputees with chronic low back pain experience compounded physical activity avoidance and functional limitations. • Chronic low back pain in amputees erodes quality of life more than people with back pain or amputation alone. • Therapeutic interventions, such as core strengthening and stabilization exercises, have strong potential to provide low back pain relief for amputees.

Exercise intervention for unilateral amputees with low back pain: Study protocol for a randomised, controlled trial

Article

Full-text available

Dec 2017
TRIALS

Background: Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens. Methods/design: This study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18-60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRSpain). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count. Discussion: The study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that contribute to back pain in unilateral transtibial amputees with chronic LBP. We will determine the relative contribution of the exercise-induced changes in these factors on pain responsiveness in this population. Trial registration: ClinicalTrials.gov, ID: NCT03300375 . Registered on 2 October 2017.

Resistance training in addition to multidisciplinary rehabilitation for patients with chronic pain in the low back: Study protocol

Article

Full-text available

Apr 2017

Introduction Chronic low back pain (LBP) is a major health problem worldwide. Multidisciplinary rehabilitation and exercise is recommended for the management of chronic LBP. However, there is a need to investigate effective exercise interventions that is available in clinics and as home-based training on a large scale. This article presents the design and rationale of the first randomized clinical trial investigating the effects of progressive resistance training with elastic bands in addition to multidisciplinary rehabilitation for patients with moderate to severe chronic LBP. Methods and analysis We aim to enroll 100 patients with chronic LBP referred to a specialized outpatient hospital clinic in Norway. Participants will be randomized equally to either; a) 3 tion including whole-body progressive resistance training using elastic bands – followed by home-based progressive resistance training for 9 weeks, or b) 3 weeks of multidisciplinary rehabilitation including general physical exercise – followed by home-based general physical exercise for 9 weeks. Questionnaires and strength tests will be collected at baseline, weeks 3 and 12, and at 6 and 12 months. The primary outcome is between-group changes in pain-related disability at week 12 assessed by the Oswestry disability index. Secondary outcomes include pain, work ability, work status, mental health, health-related quality of life, global rating of change, general health, and muscular strength and pain-related disability up to 12 months of follow-up. Discussion This study will provide valuable information for clinicians working with patients with chronic LBP. Trial registration ClinicalTrials.gov, number NCT02420236.

The use of periodization in exercise prescriptions for inactive adults: A systematic review

Article

Full-text available

May 2015

Background: Periodization of exercise is a method typically used in sports training, but the impact of periodized exercise on health outcomes in untrained adults is unclear. Purpose: This review aims to summarize existing research wherein aerobic or resistance exercise was prescribed to inactive adults using a recognized periodization method. Methods: A search of relevant databases, conducted between January and February of 2014, yielded 21 studies published between 2000 and 2013 that assessed the impact of periodized exercise on health outcomes in untrained participants. Results: Substantial heterogeneity existed between studies, even under the same periodization method. Compared to baseline values or non-training control groups, prescribing periodized resistance or aerobic exercise yielded significant improvements in health outcomes related to traditional and emerging risk factors for cardiovascular disease, low-back and neck/shoulder pain, disease severity, and quality of life, with mixed results for increasing bone mineral density. Conclusions: Although it is premature to conclude that periodized exercise is superior to non-periodized exercise for improving health outcomes, periodization appears to be a feasible means of prescribing exercise to inactive adults within an intervention setting. Further research is necessary to understand the effectiveness of periodizing aerobic exercise, the psychological effects of periodization, and the feasibility of implementing flexible non-linear methods.

Results of a domiciliary rehabilitation program for chronic low back pain patients

Article

Full-text available

Dec 2014

Luiz Roberto Vialle

Objective: To evaluate the results of a home rehabilitation program for patients with chronic low back pain through the evaluation of abdominal muscle strength, lumbar mobility, daily activities and improved levels of pain. A secondary objective was to evaluate the adherence of the participants to this program. Methods: We evaluated 99 patients divided into case group (69 patients with chronic low back pain without indication for surgical treatment) and control group (30 patients without low back pain), the following parameters being measured: 1) lumbar mobility, 2) strength of the abdominal muscles, 3) pain by visual analog scale (VAS), 4) limitation in daily activities (Oswestry scale). Patients received individualized guidance on home exercises to be performed during two months. For comparison of groups "control" and "case" the nonparametric Mann Whitney test was applied. For comparison of the times "before" and "after" in the group of patients who returned, the nonparametric Wilcoxon test was applied. Results: Of the 69 patients who agreed to participate, 30 completed the targeted exercises within two months and returned for the final evaluation. At baseline, there was a significant difference (p<0.05) between the case and control groups for lumbar mobility and abdominal strength. In the case group there was significant improvement in all aspects evaluated at the end of the exercise program. Conclusion: The home rehabilitation program was effective as a treatment option for low back pain. Treatment adherence was low, this being the main limiting factor.

A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial)

Article

Oct 2012

Evidence supports exercise-based interventions for the management of neck pain, however there is little evidence of its superiority over usual physiotherapy. This study investigated the effectiveness of a group neck and upper limb exercise programme (GET) compared with usual physiotherapy (UP) for patients with non-specific neck pain. A total of 151 adult patients were randomised to either GET or UP. The primary measure was the Northwick Park Neck pain Questionnaire (NPQ) score at six weeks, six months and 12 months. Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point. Both interventions resulted in modest significant and clinically important improvements on the NPQ score with a change score of around 9% between baseline and 12 months. Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain, however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

Article

Full-text available

Nov 2023
J OCCUP REHABIL

Purpose Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE. Results We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = − 0.33, 95% CI − 0.58 to − 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = − 0.31, 95% CI − 0.57 to − 0.05) (moderate certainty evidence). Conclusions With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.

Effects of Complex Pain Control Programs on Taekwondo Athletes with Recurrent Low Back Pain: A Case Study

Article

Full-text available

Jul 2023

Background and Objectives: Practitioners of martial arts such as Taekwondo are likelier to experience back pain during training or competition. As the back pain of taekwondo athletes shows various symptoms depending on the athlete’s characteristics, such as technique and movement, a case study was conducted to verify the intervention effect suitable for individual traits. We examined the effects of a complex pain control program on pain, mechanosensitivity, and physical function in a Taekwondo athlete with recurrent low back pain (LBP). Materials and Methods: A Taekwondo athlete with LBP was recruited from D University, Busan. The intervention program was performed for 45 min twice a week for 3 weeks, and the patient was followed up with after 2 weeks. The numerical rating pain scale (NRPS), pain pressure threshold, mechanosensitivity, and Oswestry Disability Index (ODI) scores were measured before and after the intervention. Therapeutic massage and nerve stimulation therapy were performed. Lumbar flexion, extension, and rotation were performed in the movement control exercise group, whereas the sliding technique, a neurodynamic technique of the tibial nerve, was applied in the neurodynamic technique group. This effect was verified by comparing the average measured values before and after the intervention. Results: Pain (NRPS) and mechanosensitivity reduced, range of motion and tactile discrimination abilities improved, and physical function (ODI) improved. The effect of the improved intervention lasted 2 weeks. Conclusions: These results indicate that application of complex pain control programs considering the four aspects of pain mechanisms for 3 weeks can be an effective intervention in Taekwondo athletes with recurrent LBP.

Resistance Training Improves Physical Fitness and Reduces Pain Perception in Workers with Upper Limb Work-Related Musculoskeletal Disorders: A Pilot Study

Article

Full-text available

Sep 2022

Work-related musculoskeletal disorders (WRMDs) are a cause of productivity loss and disability. Resistance training (RT) and stretching seems to relieve pain, reducing the relative workload via an improvement in range of motion. Sixteen women (age: 48.69 ± 5.88 years old, working career duration as a packager: 22.75 ± 2.18 years) were recruited to participate in a 14-week work-based RT and stretching program. Specific exercise training (SET) targeting all body areas affected by WRMDs was performed after week 6. Physical fitness was measured via the 2 min step test (2MST), the back scratch test and the handgrip test (HG). To evaluate the level of pain in the cervical spine, shoulder, elbow and wrist, the visual analogue scale (VAS) was used. Differences were verified with a t-test. The cervical spine (p = 0.02) and left wrist (p = 0.04) VAS decreased, whereas the HG for both right (p = 0.01) and left (p = 0.01) hands and the 2MST (p = 0.01) improved. Participants with WRMDs affecting the cervical spine reported a 3.72 higher VAS score for the neck at the beginning of the protocol (p = 0.03). The protocol improved the physical fitness of participants but showed a limited effect on WRMD pain. The mean adherence was 86.2%, which indicated that exercise performed in the workplace is well accepted and could be used for pain management.

Kinesiophobia and associated factors among patients with chronic non-specific low back pain

Article

Jul 2022

Purpose: This study determined the association between kinesiophobia and age, body mass index, highest educational status, self-efficacy, pain intensity, and disability in chronic non-specific low back pain (CNSLBP) patients. Predictors of kinesiophobia were also assessed. Methods: This cross-sectional design utilised 224 CNSLBP patients in tertiary hospitals in Nigeria. The Tampa Scale of Kinesiophobia, Oswestry Disability Index, Pain Self-Efficacy Questionnaire, and Numerical Pain Rating Scale were used to assess kinesiophobia, disability, self-efficacy, and pain intensity respectively. Spearman's correlation and multiple regression analysis determined the association between the variables of interest and the predictors of kinesiophobia, respectively. Results: Most of the participants reported a high level of kinesiophobia (92%), low level of self-efficacy (68.8%), moderate pain intensity (58.0%), and moderate disability (57.1%). A significant positive weak correlation was observed between kinesiophobia and pain intensity (r = 0.138, p = 0.040). Gender, self-efficacy, pain intensity, and disability significantly predicted the extent of kinesiophobia (p < 0.05). Conclusion: The increased levels of kinesiophobia are a cause for concern and highlight the need for kinesiophobia and related factors to be closely monitored and incorporated into preventive and curative rehabilitation programmes for CNSLBP patients to minimise the negative impact on rehabilitation outcomes.Implications for RehabilitationPatients with chronic non-specific low back pain (CNSLBP) have high levels of kinesiophobia, which could predispose them to avoidance behaviours, physical inactivity, and deterioration of health, all of which, if not addressed, may result in poor rehabilitation outcomes, setting off a viscious cycle.Regular kinesiophobia assessments could indicate areas of rehabilitation concern, allowing health care providers to better target rehabilitation programs and improve rehabilitation outcomes.Pain severity, self-efficacy, and disability should be frequently assessed and included when planning rehabilitation programs, to reduce the detrimental impact on kinesiophobia.In patients with CNSLBP, graded exposure therapy to movement is necessary to prevent and reduce kinesiophobia, thereby increasing compliance during rehabilitation programs.

Does a powerlifting inspired exercise programme better compliment pain education compared to bodyweight exercise for people with chronic low back pain? A multicentre, single-blind, randomised controlled trial

Article

Apr 2022

Background Contemporary management of chronic low back pain involves combined exercise and pain education. Currently, there is a gap in the literature for whether any exercise mode better pairs with pain education. The purpose of this study was to compare general callisthenic exercise with a powerlifting style programme, both paired with consistent pain education, for chronic low back pain. We hypothesised powerlifting style training may better compliment the messages of pain education. Methods An 8-week single-blind randomised controlled trial was conducted comparing bodyweight exercise (n = 32) with powerlifting (n = 32) paired with the same education, for people with chronic low back pain. Exercise sessions were one-on-one and lasted 60-min, with the last 5–15 min comprising pain education. Pain, disability, fear, catastrophizing, self-efficacy, anxiety, and depression were measured at baseline, 8-weeks, 3-months, and 6-months. Results No significant between-group differences were observed for pain ( p≥0.40), or disability ( p≥0.45) at any time-point. Within-group differences were significantly improved for pain ( p ≤ 0.04) and disability ( p ≤ 0.04) at all time-points for both groups, except 6-month disability in the bodyweight group ( p = 0.1). Behavioural measures explained 39–60% of the variance in changes in pain and disability at each time-point, with fear and self-efficacy emerging as significant in these models ( p ≤ 0.001) Conclusions Both powerlifting and bodyweight exercise were safe and beneficial when paired with pain education for chronic low back pain, with reductions in pain and disability associated with improved fear and self-efficacy. This study provides opportunity for practitioners to no longer be constrained by systematic approaches to chronic low back pain.

Comparing the relations of demographic indicators, health status and physical fitness, socioeconomic indicators and sexual function with quality of life in women with chronic non-specific low back pain

Article

Full-text available

Jan 2022

Introduction: Low back pain is one of the most common musculoskeletal problems. Various complications such as disability, depression, anxiety, sleep disorders, stress, decreased sexual function and quality of life have been reported with chronic low back pain. Objective: The aim of this study was to compare the relationship between demographic, health status and physical fitness, socio-economic indicators and sexual function indicators on the quality of life of women with chronic non specific low back pain. Method: The present cross-sectional study was performed in 2020 in the private center of Cyrus Physiotherapy in Tehran, Iran. Thirty married women with non-specific chronic low back pain who were sexually active and living in Tehran were included in the study based on inclusion and exclusion criteria. At first, the goals and process of the study were explained to them and they were given written consent to participate in the study. Then demographic information was recorded and pain, sexual function and quality of life were measured using relevant tools. This study was reviewed and approved by the ethics committee of the University of Social Welfare and Rehabilitation Sciences (Ethics Code: IR.USWR.REC.1399.083) . IBM SPSS Statistics v22 software was used for statistical tests. Pearson correlation test was used to examine the relationship between the above variables. Results: The mean and S.D of age of participants was 38.6 ± 7.48 years . Pearson correlation test analysis showed that between quality of life with body mass index (R = -. 406, P = .026) inversely, and with sexual function score (R = .379, P = .039), general health status (R = .436, P = .016), physical fitness status (R = .406, P = .026 ) and level of education (R = .463, P = .010)) There is a significant direct relationship, but between quality of life with age (R = -. 172, P = .364), number of children (-166. R =, P = .382), pain intensity (R = -. 181, P = .339) and regular exercise (R = - .159, P= 40 .402), no significant relationship was found. Quality of life, respectively, showed a stronger relationship with education level, health status, physical fitness status and body mass index, and finally sexual performance index. Discussion & Conclusion: In women with chronic non-specific back pain participating in the present study, the lower the body mass index, the higher the level of education and sexual function score, as well as the general health and physical fitness status. The quality of life of the present study participants was better. However, the results of this study did not confirm the relationships between quality of life and age, number of children, pain intensity and regular exercises. Improving education, health status, fitness status and body mass index, and sexual function index help improve quality of life.

Exercise-Based Biopsychosocial Management of Chronic Low Back Pain

Thesis

Full-text available

Nov 2021

Mitchell Gibbs

Chronic low back pain carries a large global burden of disease. Currently, exercise is recognised as a key treatment for chronic low back pain. However, management of chronic low back pain presents exercise-based practitioners with numerous, confusing, and conflicting treatment options. Broadly, these options can be classified under biomedical or biopsychosocial treatment paradigms. An overarching problem within chronic low back pain literature is the understanding of if practitioners are applying best practice approaches, and if not, how this can be improved. Based on these evident gaps in our understanding of the management of chronic low back pain, this thesis investigated the following: How do exercise-based practitioners currently manage chronic low back pain, and what attitudes and beliefs underpin this management? What does a pragmatic biopsychosocial exercise-based approach to chronic low back pain look like, and what role does exercise play in this intervention? Can education targeted at current gaps in practice by exercise-based practitioners, combined with pragmatic understanding of biopsychosocial exercise prescription, improve clinical decision making? This thesis examined chronic low back pain at the level of the patient and of the practitioner. This thesis found exercise not to be a significant factor in the design of combined exercise and education interventions for chronic low back pain. This finding allows practitioners to move away from systemised approaches to exercise for chronic low back pain and explore prescriptions optimal for the individual patient, rather than optimal for back pain in general. However, this thesis also found practitioners with biomedical beliefs, even when concomitant with biopsychosocial beliefs, are less likely to apply these contemporary approaches. Indeed, targeted education does improve clinical decision-making through a reduction in biomedical beliefs, which increases the care provided to patients. This improvement in clinical decision-making through a reduction in biomedical beliefs, and no change to biopsychosocial, may suggest the relative importance of biomedical beliefs on approaches to chronic low back pain.

Prescription of individual therapeutic exercises via smartphone app for patients suffering from non-specific back pain: A qualitative feasibility and quantitative pilot study

Article

Full-text available

Feb 2020

Background The purpose of this qualitative study was the assessment of the feasibility and acceptance of orthopedists prescribing individualized therapeutic exercises via a smartphone app to patients suffering from non-specific back pain. Methods A total of 27 patients (mean age 44.8 ± 13.2 years) diagnosed with acute non-specific back pain were prescribed individually chosen therapy exercises via a smartphone app. Before the patients started and after 4 weeks of exercising all participants went through an assessment protocol consisting of questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], International Physical Activity Questionnaire [IPAQ], Work Ability Index [WAI], Visual Analogue Scale [VAS] back pain, sociodemographic parameters), assessment of functional parameters (handgrip strength, timed up and go test). With 16 randomly chosen patients semi-structured interviews were undertaken at the end of the intervention period. Interview transcripts were analyzed using thematic analysis. Power analysis and a priori sample size calculations were undertaken with the quantitative data. Results From the interviews four thematic categories emerged: prior exercise experience, evaluation of exercise intensity, communication with physician via smartphone app, and variability of exercise location. Quantitative analysis of secondary data showed significant improvements in back pain (ODI) as well as quality of life domains “physical functioning”, “bodily pain” and “vitality” (SF-36) of which “bodily pain” was sufficiently powered with the current sample size. Conclusion The prescription of therapeutic exercises via smartphone app to patients suffering from non-specific back pain is feasible and well-accepted in patients at all ages. Pilot data additionally pointed towards efficacy of the intervention.

Periodization and Physical Therapy: Bridging the Gap between Training and Rehabilitation

Article

Full-text available

Sep 2015
PHYS THER SPORT

Background: Exercise prescription and training progression for competitive athletes has evolved considerably in recent decades, as strength and conditioning coaches increasingly use periodization models to inform the development and implementation of training programs for their athletes. Similarly, exercise prescription and progression is a fundamental skill for sport physical therapists, and is necessary for balancing the physiological stresses of injury with an athlete’s capacity for recovery. Objective: This article will provide the sport physical therapist with an overview of periodization models and their application to rehabilitation. Summary: In recent decades models for exercise prescription and progression also have evolved in theory and scope, contributing to improved rehabilitation for countless athletes, when compared to care offered to athletes of previous generations. Nonetheless, despite such advances, such models typically fail to fully bridge the gap between such rehabilitation schemes and the corresponding training models that coaches use to help athletes peak for competition. Greater knowledge of these training systems, also known as periodization models, can help sport physical therapists in their evaluation, clinical reasoning skills, exercise progression, and goal setting for the sustained return of athletes to high level competition.

The Effects of a Free Weight Based Strength Training Intervention on Pain, Lumbar Fat Infiltration and Biomechanics

Article

Full-text available

Jun 2015

Background Chronic low back pain is one of the most prevalent musculoskeletal impairments in Western society with a mean prevalence rate of 18.1% reported in the literature (1). Exercise therapy is suggested as an intervention for those with low back pain by the American College of Physicians and the American Pain Society (2). Hayden et al (3) suggested in their systematic review of exercise therapy effects on low back pain that strength training was mean ranked as more effective than aerobic, coordination or mobilization training. Whole body strength training (4) has been shown to have positive impacts on low back pain. However, the use of free weight compound weight lifting exercises as the primary strength training tool in an intervention has limited coverage. Objectives The aim of the current study is to investigate the effects of a free weight based strength training intervention on pain, low back muscular endurance, lumbar fat infiltration and biomechanics. Methods Participants had presented to their physician with low back pain that had lasted for longer than 3 months with or without radicular pain, and were between 16 and 60 years of age. Exclusion criteria were previous spinal surgery, tumours, nerve root entrapment accompanied by neurological deficit, spinal infection and inflammatory disease of the spine. Throughout the study they filled out a visual analogue scale (VAS), an Oswestry Disability Index (ODI) questionnaire and a Euro-Qol v2 questionnaire as measures of pain, disability and quality of life. Kinematic and kinetic data for 3 bodyweight squats. Participants then completed a Biering-Sorensen (BS) test. The participants then completed 16 weeks of free weight whole body resistance training. Magnetic resonance images were obtained prior to and post intervention in order to measure lumbar fat infiltration. This was measured at L3/L4, L4/L5 and L5/S1 levels. Region of interest was the area of erector spinae and multifidus and percentage fat infiltration was calculated. Results Significant (p≤0.05) improvements of 72%, 76% and 27% were seen in VAS, ODI and Euro-Qol respectively. A significant (p≤0.05) increase of 20% in BS time to exhaustion was observed but no significant increase was seen in maximum force produced in the mid thigh pull. Significant reductions (p≤0.05) were seen in percentage fat infiltration bilaterally at the L3/L4 (left 23% right 22%) and L4/L5 (left 18% right 14%) levels. Significantly (p≤0.05) lower squats were seen across the group. Conclusions This study demonstrates that whole body, free weight resistance training can be used as an effective tool for rehabilitating those with low back pain. Improvements are multifactoral and include changes in muscle physiology, biomechanics and muscular endurance. References Disclosure of Interest None declared

Effects of an 8-week corrective program (William-based) on lumbar angle and flexibility of lumbosacral muscles in females aged 15 to 18 years old

Article

Full-text available

Mar 2015

There are many types of treatments and recommendations for restoring back deformities depending on doctors' knowledge and opinions. The purpose of the exercises is to reduce pain and to ensure stability of the lower trunk by toning the abdominal muscles, buttocks and hamstrings. Given the duration of flares and relapses rate, it is important to apply an efficient and lasting treatment. To evaluate the effects of 8 weeks of William's training on flexibility of lumbosacral muscles and lumbar angle in females with Hyperlordosis. Forty female students with lumbar lordosis more than normal degrees (Hyperlordotic) that randomly divided into exercise and control groups were selected as the study sample. The lumbar lordosis was measured using a flexible ruler, flexibility of hamstring muscles was measured with the active knee extension test, the hip flexor muscles was measured using Thomas test, the lumbar muscles flexibility measures by Schober test, abdominal muscles strength measured by Sit-Up test and back pain was measured using McGill's Visual Analogue Scales (VAS) questionnaire. Data were compared before and post-test using independent and paired t-testes. Results showed that 8 weeks of William's exercise led to significant increase in lumbar angle, flexibility of hamstring muscles, hip flexor muscles flexibility, lumbar extensor muscles flexibility, abdominal muscles strength and back pain. The findings show that William's corrective training can be considered as a useful and valid method for restoring and refining back deformities like as accentuated back-arc and became wreaked muscles' performance in lumbar areas.

Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials

Article

Feb 2015

To determine, for adults with chronic low back pain, which exercise interventions are the most effective at reducing pain compared to other treatments. A search of MEDLINE, CINAHL, EMBASE, SPORTDiscus, PsycINFO and The Cochrane Library was conducted up to October 2014. Databases were searched for published reports of randomised trials that investigated the treatment of chronic low back pain of non-specific origin with an exercise intervention. Two authors independently reviewed and selected relevant trials. Methodological quality was evaluated using the Downs and Black tool. Forty-five trials met the inclusion criteria and thirty-nine were included in the meta-analysis. Combined meta-analysis revealed significantly lower chronic low back pain with intervention groups using exercise compared to a control group or other treatment group (Standard Mean Deviation (SMD) =-0.32, CI 95% -0.44 to -0.19, P<0.01). Separate exploratory subgroup analysis showed a significant effect for strength/resistance and coordination/stabilisation programs. Our results found a beneficial effect for strength/resistance and coordination/stabilisation exercise programs over other interventions in the treatment of chronic low back pain and that cardiorespiratory and combined exercise programs are ineffective. © The Author(s) 2015.

Resistance Exercise, Disability, and Pain Catastrophizing in Obese Adults with Back Pain

Article

Full-text available

Sep 2014

Purpose: The purpose of this study was to compare the effects of two different resistance exercise protocols on self-reported disability, fear avoidance beliefs, pain catastrophizing, and back pain symptoms in obese, older adults with low back pain (LBP). Methods: Obese adults (n = 49, 60-85 yr) with chronic LBP were randomized into a total body resistance exercise intervention (TOTRX), lumbar extensor exercise intervention (LEXT), or a control group (CON). Main outcomes included perceived disability (Oswestry Disability Index, Roland Morris Disability Questionnaire). Psychosocial measures included the Fear Avoidance Beliefs survey, Tampa Scale of Kinesiophobia, and Pain Catastrophizing Scale. LBP severity was measured during three functional tasks: walking, stair climbing, and chair rise using an 11-point numerical pain rating scale. Results: The TOTRX group had greater reductions in self-reported disability scores due to back pain (Oswestry Disability Index, Roland Morris Disability Questionnaire) compared with those in the LEXT (P < 0.05). The Pain Catastrophizing Scale scores decreased in the TOTRX group compared with that in the CON group by month 4 (64.3% vs 4.8%, P < 0.05). Pain severity during chair rise activity and walking was decreased in both the LEXT and TOTRX groups relative to the CON group. Conclusions: Greater reductions in perceived disability due to LBP can be achieved with TOTRX compared with those achieved with LEXT. Pain catastrophizing and pain severity decreased most with TOTRX. The positive change in psychological outlook may assist obese, older adults with chronic back pain in reconsidering the harmfulness of the pain and facilitate regular participation in other exercise programs.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis

Article

Full-text available

Nov 2023

Purpose Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients. Methods We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain. Results This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), −2.11; 95% CI, −3.62 to −0.61], yoga (SMD, −1.76; 95% CI −2.72 to −0.81), Pilates exercise (SMD, −1.52; 95% CI, −2.68, to −0.36), and sling exercise (SMD, −1.19; 95% CI, −2.07 to −0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, −2.42; 95% CI, −3.81 to −1.03) and yoga (SMD, −2.07; 95% CI, −2.80 to −1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, −1.72; 95% CI, −2.91 to −0.53) and core or stabilization exercises (SMD, −1.04; 95% CI, −1.80 to −0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, −1.81; 95% CI, −2.78 to −0.83) and core or stabilization exercises (SMD, −1.13; 95% CI, −1.66 to −0.59) showed a better physical function improvement than no intervention provided. Conclusion Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis

Article

Jun 2022

Objective: To determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP). Design: Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). Literature search: Six electronic databases were systematically searched from inception to July 2021. Study selection criteria: RCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (18-65 years) with chronic LBP. Data synthesis: We followed the PRISMA-NMA statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to SUCRA values. Results: We included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and McKenzie method (for reducing disability). The most effective interventions for reducing pain were: Pilates, mind-body and core-based exercises. The most effective interventions for reducing disability were: Pilates, strength and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%). Conclusion: Although most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programmes were those that included: (i) at least 1-2 sessions/week of Pilates or strength exercises; (ii) sessions of <60 min of core-based, strength or mind-body exercises; and, (iii) training programs from 3 to 9 weeks of Pilates and core-based exercises.

Exercise therapy for chronic low back pain

Article

Sep 2021
COCHRANE DB SYST REV

Background: Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. Objectives: The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. Search methods: We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. Selection criteria: We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. Data collection and analysis: Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. Main results: We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. Authors' conclusions: We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-analysis

Article

Full-text available

Apr 2022
SPORTS MED

Background: Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. Design: Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. Eligibility criteria: Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). Results: We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [- 0.17, 2.06], P = 0.098, I2 = 92.4%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 1.02 [0.67, 1.36], P < 0.001, I2 = 92.99%, studies: n = 42), usual-care controls (g [95% CI]: 0.65 [0.41, 0.89], P < 0.001, I2 = 84.82%, studies: n = 33), and when all controls combined (g [95% CI]: 0.86 [0.64, 1.07], P < 0.001, I2 = 91.37%, studies: n = 79). Conclusions: There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.

Exercise Recommendations for Cardiac Patients with Chronic Nonspecific Low Back Pain

Article

Dec 2019

Peter Ronai

Musculoskeletal comorbidities (MSKCs) are the most frequent cause of activity limitations in persons with cardiovascular disease (CVD) and affect as many as 70% of this population. It has been observed that over 50% of new outpatient cardiac rehabilitation participants experience some musculoskeletal pain, with back pain reported by up to 38% of cardiac rehabilitation patients. Back pain can limit performance of activities of daily living (ADLs) and reduce exercise tolerance and compliance during outpatient cardiac rehabilitation (CR). This article will describe ways to facilitate CR exercise participation in patients who have comorbid, chronic nonspecific low back pain (CNSLBP) and have been medically cleared to exercise.

Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis

Article

Full-text available

Oct 2019

Objective Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). Design Network meta-analysis (NMA). Data sources MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL. Eligibility criteria Exercise training randomised controlled/clinical trials in adults with NSCLBP. Results Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): −1.86 (–2.54 to –1.19)), resistance (SUCRA=80%; −1.14 (–1.71 to –0.56)) and stabilisation/motor control (SUCRA=80%; −1.13 (–1.53 to –0.74)) for physical function and resistance (SUCRA=80%; −1.26 (–2.10 to –0.41)) and aerobic (SUCRA=80%; −1.18 (–2.20 to –0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10%; 0.09 (–0.71 to 0.89)) and physical function (SUCRA=20%; −0.31 (–0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20%; −0.31 (–1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p>0.095; SUCRA<40%). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria. Summary/conclusion There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.

Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective

Article

Oct 2019

Chronic non‐specific low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment, however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioural therapy, acupuncture and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this paper is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living and body composition), psychological (kinesiophobia, fear‐avoidance, pain catastrophizing, pain self‐efficacy, depression, anxiety and sleep quality), social (social functioning and work absenteeism) and health‐related quality of life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered ‘real’ in an individual patient. This information can guide treatment selection when working with an individual with CLBP.

Comparison of Trunk Muscle Activity Between Traditional Plank Exercise and Plank Exercise With Isometric Contraction of Ankle Muscles in Subjects With Chronic Low Back Pain

Article

May 2019

Choi, JH, Kim, DE, and Cynn, HS. Comparison of trunk muscle activity between traditional plank exercise and plank exercise with isometric contraction of ankle muscles in subjects with chronic low back pain. J Strength Cond Res XX(X): 000-000, 2019-This study aimed to compare the effects of 4 different ankle conditions on the activities of rectus abdominis (RA), external oblique (EO), transversus abdominis/internal oblique (TrA/IO), and erector spinae (ES) muscles during plank exercise in subjects with chronic low back pain (CLBP). Twenty-two subjects with CLBP participated in this study. The subjects performed the traditional plank and plank with 3 different ankle muscle contraction types (isometric contraction of ankle dorsiflexor, plantarflexor, and without ankle muscle contraction). Surface electromyography was used to measure the activities of RA, EO, TrA/IO, ES, tibialis anterior, and gastrocnemius muscles. A 1-way repeated-measures analysis of variance was used to assess the statistical significance of activities of the RA, EO, TrA/IO, and ES muscles. The activities of RA, EO, and TrA/IO muscles were significantly greater in the plank with isometric contraction of ankle dorsiflexor (PlankDF) than in the other 3 plank exercises. No significant difference in the activity of ES muscles was revealed during the 4 plank exercises. The activities of all abdominal muscles during PlankDF were significantly higher than those during the traditional plank, as well as during the plank with isometric contraction of ankle plantarflexor (PlankPF) and the plank without ankle muscular contraction (Plankw/o), and more than 60% of maximal voluntary isometric contraction was observed. Thus, PlankDF could be applied not only as a rehabilitation strategy for patients with decreased core stability owing to weakness of abdominal muscles but also as fitness program for improving core strength.

The Consensus on Exercise Reporting Template (CERT) applied to exercise interventions in musculoskeletal trials demonstrated good rater agreement and incomplete reporting

Article

Jul 2018
J CLIN EPIDEMIOL

Objective: To determine inter-rater agreement and utility of the Consensus on Exercise Reporting Template (CERT) for evaluating reporting of musculoskeletal exercise trials. Study design and setting: Two independent reviewers applied the CERT to a random sample of 20 exercise trials published 2010 to 2015 identified from searches of PEDro, CENTRAL and PubMed. Reviewers recorded whether each item criterion was met, detailed missing data and appraisal time Percent agreement and the Prevalence and Bias Adjusted Kappa (PABAK) statistic were used to measure inter-rater agreement. Results: The trials included a range of musculoskeletal conditions (back/neck pain, hip/knee osteoarthritis, tendinopathies). For percent agreement, inter-rater agreement was high (13 items >80%) and for PABAK substantial (9 items: 0.61 - 0.80) and excellent (3 items: 0.81-1.0). Agreement was lower for starting level decision rule (percent agreement: 55%, PABAK 0.30); tailoring of exercise (%A: 65%, PABAK 0.40 (95% CI: 0.00 to 0.80)); exercise equipment (percent agreement: 70%, PABAK 0.30); and motivation strategies (percent agreement: 70%, PABAK 0.40). Sixty percent of descriptions were missing information for >50% of CERT items. Mean appraisal time was 30 minutes and the majority of interventions required access to other published papers. Discussion and conclusions: The CERT has good inter-rater agreement and can comprehensively evaluate reporting of exercise interventions. Most trials do not adequately report intervention details and information can be difficult to obtain. Incomplete reporting of effective exercise programs may be remedied by using the CERT when constructing, submitting, reviewing and publishing manuscripts.

Methodological issues in work disability prevention research

Chapter

Jan 2013

Methodological issues can be encountered in work disability prevention research. The complexity of this field requires different disciplinary perspectives and methodological approaches. Methodological challenges encountered with workplaces as the setting, reluctant respondents, ethical issues and stakeholders are discussed. © Springer Science+Business Media New York 2013. All rights reserved.

Atrophy of gluteus maximus among women with a history of chronic low back pain

Article

Full-text available

Jul 2017
PLOS ONE

Background Although the relationship between low back pain (LBP) and the size of certain trunk muscles has been extensively studied, the relationship between gluteus maximus (GM) size and LBP has been only minimally examined. Determining whether such a relationship exists would help improve our understanding of the etiology of LBP, and possibly provide a rationale for the use of therapeutic exercise interventions targeting GM with LBP patients. The objective of this study was to compare gluteus maximus cross-sectional area in individuals with chronic LBP, and in a group of individuals without LBP. Our hypothesis was that individuals with LBP would have greater atrophy in their gluteus maximus muscles than our control group. Materials and methods For this case-control study, we analyzed medical history and pelvic computed tomography (CT) scans for 36 female patients with a history of chronic LBP, and 32 female patients without a history of LBP. Muscle cross-sectional area of gluteus maximus was measured from axial CT scans using OsiriX MD software, then was normalized to patient height, and used to compare the two groups. The number of back pain-related medical visits was also correlated with gluteus maximus cross-sectional area. Results Mean normalized cross-sectional area was significantly smaller in the LBP group than in the control group, with t = 2.439 and P<0.05. The number of back pain-related visits was found to be significantly correlated with normalized cross-sectional area, with r = -0.270 and P<0.05. The atrophy seen in the present research may reflect incidental disuse atrophy seen with LBP, which is present in many muscle groups after prolonged immobilization or with a sedentary lifestyle. Conclusions This research demonstrated a previously only minimally explored relationship between gluteus maximus cross-sectional area and LBP in women. Further research is indicated in individuals with varying age, sex, and LBP diagnoses.

Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline

Article

Feb 2017
ANN INTERN MED

Background: A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. New evidence is now available. Purpose: To systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data sources: Ovid MEDLINE (January 2008 through February 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Study selection: Randomized trials of 9 nonpharmacologic options versus sham treatment, wait list, or usual care, or of 1 nonpharmacologic option versus another. Data extraction: One investigator abstracted data, and a second checked abstractions for accuracy; 2 investigators independently assessed study quality. Data synthesis: The number of trials evaluating nonpharmacologic therapies ranged from 2 (tai chi) to 121 (exercise). New evidence indicates that tai chi (strength of evidence [SOE], low) and mindfulness-based stress reduction (SOE, moderate) are effective for chronic low back pain and strengthens previous findings regarding the effectiveness of yoga (SOE, moderate). Evidence continues to support the effectiveness of exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain (SOE, low to moderate). Limited evidence shows that acupuncture is modestly effective for acute low back pain (SOE, low). The magnitude of pain benefits was small to moderate and generally short term; effects on function generally were smaller than effects on pain. Limitation: Qualitatively synthesized new trials with prior meta-analyses, restricted to English-language studies; heterogeneity in treatment techniques; and inability to exclude placebo effects. Conclusion: Several nonpharmacologic therapies for primarily chronic low back pain are associated with small to moderate, usually short-term effects on pain; findings include new evidence on mind-body interventions. Primary funding source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42014014735).

S1 Table

Data

Full-text available

Oct 2016

Characteristics of included trials. A table showing the characteristics of included trials and their references. (PDF)

The effect of journal impact factor, reporting conflicts, and reporting funding sources, on standardized effect sizes in back pain trials: a systematic review and meta-regression

Article

Full-text available

Nov 2015
BMC MUSCULOSKEL DIS

Background Low back pain is a common and costly health complaint for which there are several moderately effective treatments. In some fields there is evidence that funder and financial conflicts are associated with trial outcomes. It is not clear whether effect sizes in back pain trials relate to journal impact factor, reporting conflicts of interest, or reporting funding. Methods We performed a systematic review of English-language papers reporting randomised controlled trials of treatments for non-specific low back pain, published between 2006-2012. We modelled the relationship using 5-year journal impact factor, and categories of reported of conflicts of interest, and categories of reported funding (reported none and reported some, compared to not reporting these) using meta-regression, adjusting for sample size, and publication year. We also considered whether impact factor could be predicted by the direction of outcome, or trial sample size. Results We could abstract data to calculate effect size in 99 of 146 trials that met our inclusion criteria. Effect size is not associated with impact factor, reporting of funding source, or reporting of conflicts of interest. However, explicitly reporting ‘no trial funding’ is strongly associated with larger absolute values of effect size (adjusted β=1.02 (95 % CI 0.44 to 1.59), P=0.001). Impact factor increases by 0.008 (0.004 to 0.012) per unit increase in trial sample size (P<0.001), but does not differ by reported direction of the LBP trial outcome (P=0.270). Conclusions The absence of associations between effect size and impact factor, reporting sources of funding, and conflicts of interest reflects positively on research and publisher conduct in the field. Strong evidence of a large association between absolute magnitude of effect size and explicit reporting of ‘no funding’ suggests authors of unfunded trials are likely to report larger effect sizes, notwithstanding direction. This could relate in part to quality, resources, and/or how pragmatic a trial is.

Status of weight reduction as an intervention in physical therapy management of low back pain: Systematic review and implications

Article

Full-text available

Jun 2013

Obesity is an independent predictor of back pain and its severity, and healthy weight is associated with less pain and disability, and greater capacity to be active. Given the commitment of physical therapy to health-focused practice, we systematically reviewed current literature on physical therapy management of low back pain with special attention to body weight and its management. Relevant MeSH headings for physical therapy, low back pain and management were used to identify articles in the EMBASE database. The search was limited to randomized controlled trials and published in English over 1 year (June 2011 through May 2012). Of 53 articles meeting criteria, 35 source articles were analyzed. Of these, 17 included initial weight measurement; six included post-intervention weight measurement; five compared weights pre–post-intervention; 18 articles did not include weight as an outcome measure; and none included weight management as either a primary or secondary low back pain intervention. Although the relationship between back pain and overweight has not been established to be causal, this should not exclude its being a focus of contemporary physical therapy practice guidelines. This practice augments patient health consistent with the profession's commitment to the ICF and health-focused practice, and minimizes weight-related contribution to back pain.

Clinical Pilates versus General Exercise for Chronic Low Back Pain

Article

Mar 2013
MED SCI SPORT EXER

Systematic back muscle exercise after percutaneous vertebroplasty for spinal osteoporotic compression fracture patients: A randomized controlled trial

Article

Oct 2011
CLIN REHABIL

To analyze the clinical significance of postoperative back muscle exercises after percutaneous vertebroplasty for spinal osteoporotic compression fracture patients. Clinical randomized controlled trials of parallel group nonpharmacologic study. Patients practised back muscle exercises in the spinal surgery department, rehabilitation department and at their residences. Osteoporotic compression fracture patients who had undergone percutaneous vertebroplasty and processed sufficient muscle strength to participate in the training were studied. Patients were randomized into two groups, which were titled A and B. General postoperation therapy, including antiosteoporotic medications and education, was offered to all patients. Group B patients received additional systematic back muscle exercise. Both Oswestry Disability Index (ODI) and visual analogue scale (VAS) were recorded preoperatively and postoperatively at three-day, one-month, six-month, one-year and two-year follow-up. From January 2006 to January 2009, a total of 82 patients were assessed for eligibility, 60 patients were enrolled and randomized into two groups. Forty-two (70%) patients (20 of 30 in Group A and 22 of 30 in Group B) were successfully followed-up for two years. Systematic back muscle exercises resulted in a significant advantage in both measurements. The ODI of Group B was significantly better than Group A at the six-month, one-year and two-year follow-ups (P < 0.05). The pain level of Group B was significantly lower than in Group A at the one- and two-year follow-ups (P < 0.05). At the end of our study, the mean (SD) of the ODI in Groups A and B were 39.1 (9.14) and 23.4 (5.62); the mean (SD) of the VAS in Groups A and B were 3.4 (1.15) and 2.1 (0.84), respectively. Our findings suggest that the benefit of the exercises required at least six months to be observed; however, the favourable effects could last for two years. Therefore, systematic back muscle exercise should be recommended as one of the treatment guidelines for postpercutaneous vertebroplasty patients.

Integration of strength and conditioning principles into a rehabilitation program

Article

Full-text available

Sep 2011
Int J Sports Phys Ther

Rehabilitation and strength and conditioning are often seen as two separate entities in athletic injury recovery. Traditionally an athlete progresses from the rehabilitation environment under the care of a physical therapist and/or athletic trainer to the strength and conditioning coach for specific return to sport training. These two facets of return to sport are often considered to have separate goals. Initial goals of each are often different due to the timing of their implementation encompassing different stages of post-injury recovery. The initial focus of post injury rehabilitation includes alleviation of dysfunction, enhancement of tissue healing, and provision of a systematic progression of range-of-motion and strength. During the return to function phases, specific return to play goals are paramount. Understanding of specific principles and program parameters is necessary when designing and implementing an athlete's rehabilitation program. Communication and collaboration amongst all individuals caring for the athlete is a must. The purpose of this review is to outline the current evidence supporting utilization of training principles in athletic rehabilitation, as well as provide suggested implementation of such principles throughout different phases of a proposed rehabilitation program. THE FOLLOWING ELECTRONIC DATABASES WERE USED TO IDENTIFY RESEARCH RELEVANT TO THIS CLINICAL COMMENTARY: MEDLINE (from 1950-June 2011) and CINAHL (1982-June 2011), for all relevant journal articles written in English. Additional references were accrued by independent searching of references from relevant articles. Currently evidence is lacking in the integration of strength and conditioning principles into the rehabilitation program for the injured athlete. Numerous methods are suggested for possible utilization by the clinician in practice to improve strength, power, speed, endurance, and metabolic capacity. Despite abundance of information on the implementation of training principles in the strength and conditioning field, investigation regarding the use of these principles in a properly designed rehabilitation program is lacking.

The MOS 36-Item Short-Form Health Status Survey (SF-36), I: Conceptual framework and item selection

Article

Full-text available

Aug 1992

American College of Sports Medicine position stand. Progression models in resistance training for healthy adultsACSMMed Sci Sports Exerc20094168770810.1249/MSS.0b013e318191567019204579

Article

Full-text available

Nov 2001
MED SCI SPORT EXER

Validating the SF-36 Health Survey Questionnaire: New Outcome Measure for Primary Care

Article

Full-text available

Aug 1992

To test the acceptability, validity, and reliability of the short form 36 health survey questionnaire (SF-36) and to compare it with the Nottingham health profile. Postal survey using a questionnaire booklet together with a letter from the general practitioner. Non-respondents received two reminders at two week intervals. The SF-36 questionnaire was retested on a subsample of respondents two weeks after the first mailing. Two general practices in Sheffield. 1980 patients aged 16-74 years randomly selected from the two practice lists. Scores for each health dimension on the SF-36 questionnaire and the Nottingham health profile. Response to questions on recent use of health services and sociodemographic characteristics. The response rate for the SF-36 questionnaire was high (83%) and the rate of completion for each dimension was over 95%. Considerable evidence was found for the reliability of the SF-36 (Cronbach's alpha greater than 0.85, reliability coefficient greater than 0.75 for all dimensions except social functioning) and for construct validity in terms of distinguishing between groups with expected health differences. The SF-36 was able to detect low levels of ill health in patients who had scored 0 (good health) on the Nottingham health profile. The SF-36 is a promising new instrument for measuring health perception in a general population. It is easy to use, acceptable to patients, and fulfils stringent criteria of reliability and validity. Its use in other contexts and with different disease groups requires further research.

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection

Article

Full-text available

Jul 1992
MED CARE

A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.

Assessment of leisure time exercise behavior by self-report: A concurrent validity study

Article

Full-text available

Nov 1985

The purpose of this study was to assess the concurrent validity of a simple self-report question to measure leisure time exercise behavior. Values of body fat (BF), maximum oxygen intake (V̇O2 max) and muscular endurance (ME) expressed in percentile of appropriate age and sex categories (Canadian Norms) were used as concurrent validity criteria for the self-report measure. BF, V̇O2 max and ME were respectively predicted from the Durnin and Womersley skinfold equation, the Astrand fitness test, and the maximum number of sit ups per minute. The three ANOVA tests showed significant mean differences between subjects classified as high and low BF (p < 0.01), V̇O2 max (p < 0.05) and ME (p < 0.01). We conclude that this simple self-report question has concurrent validity for the assessment of leisure time exercise behavior.

A fitness programme for patients with chronic low back pain

Article

Full-text available

Jan 1995

To evaluate a progressive fitness programme for patients with chronic low back pain. Single blind randomised controlled trial. Assessments were carried out before and after treatment by an observer blinded to the study and included a battery of validated measures. All patients were followed up by postal questionnaire six months after treatment. Physiotherapy department of orthopaedic hospital. 81 patients with chronic low back pain referred from orthopaedic consultants for physiotherapy. The patients were randomly allocated to a fitness programme or control group. Both groups were taught specific exercises to carry out at home and referred to a back-school for education in back care. Patients allocated to the fitness class attended eight exercise classes over four weeks in addition to the home programme and backschool. Significant differences between the groups were shown in the changes before and after treatment in scores on the Oswestry low back pain disability index (P < 0.005), pain reports (sensory P < 0.05 and affective P < 0.005), self efficacy reports (P < 0.05), and walking distance (P < 0.005). No significant differences between the groups were found by the general health questionnaire or questionnaire on pain locus of control. A benefit of about 6 percentage points on the disability index was maintained by patients in the fitness group at six months. There is a role for supervised fitness programmes in the management of moderately disabled patients with chronic low back pain. Further clinical trials, however, need to be established in other centres to confirm these findings.

Successive time course of strength development and steroid hormone responses to heavy-resistance exercise

Article

Full-text available

Mar 1994

Subjects (5 males, 5 females) performed heavy-resistance exercise at a constant stimulus 3 days/wk for 8 wk. Work rates were then increased to higher but constant levels for an additional 8 wk. Half times of the first training period were 14 and 10 days for the bench press and parallel squat, respectively. The second time course resulted in only one-third of the overall magnitude of strength increases for both exercises as the first, and the kinetics were slower in the parallel squat but similar in the bench press (half time 13 days). Skeletal muscle fiber area was significantly increased (19%) in fast-twitch fibers by the end of the second training period. Postexercise elevations in serum cortisol and prolactin were seen only in the male subjects. Because the males trained at considerably higher work loads than the females, these results imply that absolute amounts of resistance may be an essential requirement for inducing certain hormonal responses. Serum cortisol levels in males after exercise were blunted by the 5th wk of the first time course. For serum testosterone, neither resting nor higher post-exercise concentrations were different at any point of the training periods for either sex. We conclude that the strength time course results are not inconsistent with current thought on factors contributing to strength accumulation. The absence of a specific serum androgenic response with strength development may be related to the fact that the constant exercise stimulus is not conducive to establishing clear-cut hormone-strength relationships.

Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. A pragmatic, randomized, single-blinded, controlled trial with 1-year follow-up

Article

Full-text available

Jan 1999

A multicenter, randomized, single-blinded controlled trial with 1-year follow-up. To evaluate the efficiency of progressively graded medical exercise therapy, conventional physiotherapy, and self-exercise by walking in patients with chronic low back pain. Varieties of medical exercise therapy and conventional physiotherapy are considered to reduce symptoms, improve function, and decrease sickness absence, but this opinion is controversial. Patients with chronic low back pain or radicular pain sick-listed for more than 8 weeks and less than 52 weeks (Sickness Certificate II) were included. The treatment lasted 3 months (36 treatments). Pain intensity, functional ability, patient satisfaction, return to work, number of days on sick leave, and costs were recorded. Of the 208 patients included in this study, 71 were randomly assigned to medical exercise therapy, 67 to conventional physiotherapy, and 70 to self-exercise. Thirty-three (15.8%) patients dropped out during the treatment period. No difference was observed between the medical exercise therapy and conventional physiotherapy groups, but both were significantly better than self-exercise group. Patient satisfaction was highest for medical exercise therapy. Return to work rates were equal for all 3 intervention groups at assessment 15 months after therapy was started, with 123 patients were back to work. In terms of costs for days on sick leave, the medical exercise therapy group saved 906,732 Norwegian Kroner (NOK) ($122,531.00), and the conventional physiotherapy group saved NOK 1,882,560 ($254,200.00), compared with the self-exercise group. The efficiency of medical exercise therapy and conventional physiotherapy is shown. Leaving patients with chronic low back pain untampered poses a risk of worsening the disability, resulting in longer periods of sick leave.

SF 36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions

Article

Full-text available

Jan 1995

To assess the responsiveness of the SF 36 health survey questionnaire to changes in health status over time for four common clinical conditions. Postal questionnaires at baseline and after one year's follow up, with two reminders at two week intervals if necessary. Clinics and four training general practices in Grampian region in the north east of Scotland. More than 1,700 patients aged 16 to 86 years with one of four conditions: low back pain, menorrhagia, suspected peptic ulcer, and varicose veins; and a random sample of 900 members of the local general population for comparison. A transition question measuring change in health and the eight scales of the SF 36 health survey questionnaire; standardised response means (mean change in score for a scale divided by the standard deviation of the change in scores) used to quantify the instrument's responsiveness to changes in perceived health status, and comparison of patient scores at baseline and follow up with those of the general population. The response rate exceeded 75% in a patient population. Changes across the SF 36 questionnaire were associated with self reported changes in health, as measured by the transition question. The questionnaire showed significant improvements in health status for all four clinical conditions, whether in referred or non-referred patients. For patients with suspected peptic ulcer and varicose veins the SF 36 profiles at one year approximate to the general population. These results provide the first evidence of the responsiveness of the SF 36 questionnaire to changes in perceived health status in a patient population in the United Kingdom.

A randomized clinical trial of three active therapies for chronic low back pain

Article

Full-text available

Jan 2000

A randomized clinical trial. To examine the relative efficacy of three active therapies for chronic low back pain. There is much evidence documenting the efficacy of exercise in the conservative management of chronic low back pain, but many questions remain regarding its exact prescription and method of application. The most successful method must be identified to enable refinement of future rehabilitation programs to target the specific needs of the patient with chronic low back pain and the budget of the healthcare provider. One hundred forty-eight patients with chronic low back pain were randomized to one of the following treatments, which they attended twice a week for 3 months: 1) modern active physiotherapy, 2) muscle reconditioning on training devices, or 3) low-impact aerobics. Pretherapy and posttherapy, objective measurements of lumbar mobility were performed, and questionnaires were administered inquiring about self-rated pain and disability, and psychosocial factors. Similar questionnaires were administered 6 months after therapy. The data were analyzed using the intention-to-treat principle. Of the 148 patients, 16 (10.8%) dropped out of the therapy. One hundred thirty-seven questionnaires (93%) were available for analysis at all three time points. After therapy, significant reductions were observed in pain intensity, frequency, and disability; Fear-Avoidance Beliefs about physical activity (FABQactivity); and "praying/hoping," "catastrophizing," and "pain behavior" coping strategies--each with no group differences in the extent of the response. These effects were maintained over the subsequent 6 months, with the exception of disability and FABQactivity for the physiotherapy group. There were small but significant posttherapy increases in lumbar mobility, with aerobics and devices showing a greater response than physiotherapy. The general lack of treatment specificity suggests that the main effects of the therapies were educed not through the reversal of physical weaknesses targeted by the corresponding exercise modality, but rather through some "central" effect, perhaps involving an adjustment of perception in relation to pain and disability. The direct costs associated with administering physiotherapy were three times as great, and devices four times as great, as those for aerobics. Administration of aerobics as an efficacious therapy for chronic low back pain has the potential to relieve some of the huge financial burden associated with the condition.

Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group

Article

Full-text available

Sep 2000

The Medical Outcomes Study 36-item Short Form (SF-36) is a widely used measure of health-related quality of life. Normative data are the key to determining whether a group or an individual scores above or below the average for their country, age or sex. Published norms for the SF-36 exist for other countries but have not been previously published for Canada. The Canadian Multicentre Osteoporosis Study is a prospective cohort study involving 9423 randomly selected Canadian men and women aged 25 years or more living in the community. The sample was drawn within a 50-km radius of 9 Canadian cities, and the information collected included the SF-36 as a measure of health-related quality of life. This provided a unique opportunity to develop age- and sex-adjusted normative data for the Canadian population. Canadian men scored substantially higher than women on all 8 domains and the 2 summary component scales of the SF-36. Canadians scored higher than their US counterparts on all SF-36 domains and both summary component scales and scored higher than their UK counterparts on 4 domains, although many of the differences are not large. The differences in the SF-36 scores between age groups, sexes and countries confirm that these Canadian norms are necessary for comparative purposes. The data will be useful for assessing the health status of the general population and of patient populations, and the effect of interventions on health-related quality of life.

Article

Full-text available

Sep 2000

The relationship between history of back pain and measurements of both health-related fitness and physical activity participation was examined in 233 males and 287 females aged 15-69 years. Participants were divided by gender into those reporting no history (NH) or a history (H) of recurring back pain. Analysis of variance indicated that trunk flexion, back extensor endurance, and physical activity participation were significantly higher for NH and waist girth significantly lower for NH in both genders. In females, mean abdominal muscular endurance was significantly higher in NH. Forward stepwise discriminant function analyses indicated that the best discriminators between NH and H were back extensor endurance and physical activity participation in both genders and waist girth in females. These findings support using measurements of trunk flexion, abdominal muscular endurance, back extensor endurance, physical activity participation, and waist girth as indicators of back fitness in the evaluation of back health.

Position stand: Progression models in resistance training for healthy adultsAmerican College of Sports MedicineMed Sci Sports Exerc20023436438011828249

Article

Full-text available

Feb 2002

In order to stimulate further adaptation toward a specific training goal(s), progression in the type of resistance training protocol used is necessary. The optimal characteristics of strength-specific programs include the use of both concentric and eccentric muscle actions and the performance of both single- and multiple-joint exercises. It is also recommended that the strength program sequence exercises to optimize the quality of the exercise intensity (large before small muscle group exercises, multiple-joint exercises before single-joint exercises, and higher intensity before lower intensity exercises). For initial resistances, it is recommended that loads corresponding to 8-12 repetition maximum (RM) be used in novice training. For intermediate to advanced training, it is recommended that individuals use a wider loading range, from 1-12 RM in a periodized fashion, with eventual emphasis on heavy loading (1-6 RM) using at least 3-min rest periods between sets performed at a moderate contraction velocity (1-2 s concentric, 1-2 s eccentric). When training at a specific RM load, it is recommended that 2-10% increase in load be applied when the individual can perform the current workload for one to two repetitions over the desired number. The recommendation for training frequency is 2-3 d x wk(-1) for novice and intermediate training and 4-5 d x wk(-1) for advanced training. Similar program designs are recommended for hypertrophy training with respect to exercise selection and frequency. For loading, it is recommended that loads corresponding to 1-12 RM be used in periodized fashion, with emphasis on the 6-12 RM zone using 1- to 2-min rest periods between sets at a moderate velocity. Higher volume, multiple-set programs are recommended for maximizing hypertrophy. Progression in power training entails two general loading strategies: 1) strength training, and 2) use of light loads (30-60% of 1 RM) performed at a fast contraction velocity with 2-3 min of rest between sets for multiple sets per exercise. It is also recommended that emphasis be placed on multiple-joint exercises, especially those involving the total body. For local muscular endurance training, it is recommended that light to moderate loads (40-60% of 1 RM) be performed for high repetitions (> 15) using short rest periods (< 90 s). In the interpretation of this position stand, as with prior ones, the recommendations should be viewed in context of the individual's target goals, physical capacity, and training status.

A Comparison of Linear and Daily Undulating Periodized Programs With Equated Volume and Intensity for Local Muscular Endurance

Article

Full-text available

Mar 2003

The purpose of this study was to compare linear periodization (LP), daily undulating periodization (DUP), and reverse linear periodization (RLP) for gains in local muscular endurance and strength. Sixty subjects (30 men, 30 women) were randomly assigned to LP, DUP, or RLP groups. Maximal repetitions at 50% of the subject's body weight were recorded for leg extensions as a pretest, midtest, and posttest. Training involved 3 sets (leg extensions) 2 days per week. The LP group performed sets of 25 repetition maximum (RM), 20RM, and 15RM changing every 5 weeks. The RLP group progressed in reverse order (15RM, 20RM, 25RM), changing every 5 weeks. The DUP group adjusted training variables between each workout (25RM, 20RM, 15RM repeated for the 15 weeks). Volume and intensity were equated for each training program. No significant differences were measured in endurance gains between groups (RLP = 73%, LP = 56%, DUP = 55%; p = 0.58). But effect sizes (ES) demonstrated that the RLP treatment (ES = 0.27) was more effective than the LP treatment (control) and the DUP treatment (ES = -0.02) at increasing muscular endurance. Therefore, it was concluded that making gradual increases in volume and gradual decreases in intensity was the most effective program for increasing muscular endurance.

Effects of Functional Restoration Versus 3 Hours per Week Physical Therapy: A Randomized Controlled Study

Article

Full-text available

Apr 2004
SPINE

Randomized parallel-group comparative trial with a 6-month follow-up period. To compare, in chronic low back pain patients, the effectiveness of a functional restoration program, including intensive physical training, occupational therapy, and psychological support to an active individual therapy consisting of 3 hours physical therapy per week during 5 weeks. Controlled studies conducted in the United States showed a benefit of functional restoration in patients with low back pain, especially on return to work. Randomized Canadian and European trials had less favorable results. In France, there has been up to now no randomized study. Controlled studies suggested a positive effect of functional restoration programs. Eighty-six patients with low back pain were randomized to either the functional restoration (44 patients) or the active individual therapy (42 patients) program. One person in each group never started the program. Two patients did not complete the functional restoration program, and one was lost to follow-up at 6 months. The mean number of sick-leave days in the 2 previous years was 6 months. After adjustment on the variable "workplace enrolled in an ergonomic program", the mean number of sick-leave days was significantly lower in the functional restoration group. Physical criteria and treatment appreciation were also better. There was no significant difference in the intensity of pain, the quality of life and functional indexes, the psychological characteristics, the number of contacts with the medical system, and the drug intake. This study demonstrates the effectiveness of a functional restoration program on important outcome measures, such as sick leave, in a country that has a social system that protects people facing difficulties at work.

A Meta-Analysis of Periodized versus Nonperiodized Strength and Power Training Programs

Article

Full-text available

Jan 2005

The purpose of this study was to quantitatively combine and examine the results of studies examining the effectiveness of periodized (PER) compared to nonperiodized (Non-PER) training programs for strength and/or power development. Two analyses were conducted to (a) examine the magnitude of treatment effect elicited by PER strength training programs compared to Non-PER programs and (b) compare these effects after controlling for training volume, frequency, and intensity. Studies meeting the inclusion criteria were coded based on characteristics that might moderate the overall effects (i.e., participant characteristics and characteristics related to the training program). Effect sizes (ESs) were calculated for each study, and an overall ES of 0.84 (+/- 1.41) favoring PER training was found. Further analyses identified the treatment effect specific to training variation to be ES = 0.25. Significant moderating variables included age, training status, and length of training program. As a result of this statistical review of the literature, it is concluded that PER training is more effective than Non-PER training for men and women, individuals of varying training backgrounds, and for all age groups. In line with the overload principle, additions to volume, intensity, and frequency result in additional training adaptations.

Quantifying Test-Retest Reliability Using The Intraclass Correlation Coefficient and the SEM

Article

Full-text available

Mar 2005

Joseph Weir

Reliability, the consistency of a test or measurement, is frequently quantified in the movement sciences literature. A common metric is the intraclass correlation coefficient (ICC). In addition, the SEM, which can be calculated from the ICC, is also frequently reported in reliability studies. However, there are several versions of the ICC, and confusion exists in the movement sciences regarding which ICC to use. Further, the utility of the SEM is not fully appreciated. In this review, the basics of classic reliability theory are addressed in the context of choosing and interpreting an ICC. The primary distinction between ICC equations is argued to be one concerning the inclusion (equations 2,1 and 2,k) or exclusion (equations 3,1 and 3,k) of systematic error in the denominator of the ICC equation. Inferential tests of mean differences, which are performed in the process of deriving the necessary variance components for the calculation of ICC values, are useful to determine if systematic error is present. If so, the measurement schedule should be modified (removing trials where learning and/or fatigue effects are present) to remove systematic error, and ICC equations that only consider random error may be safely used. The use of ICC values is discussed in the context of estimating the effects of measurement error on sample size, statistical power, and correlation attenuation. Finally, calculation and application of the SEM are discussed. It is shown how the SEM and its variants can be used to construct confidence intervals for individual scores and to determine the minimal difference needed to be exhibited for one to be confident that a true change in performance of an individual has occurred.

Diagnosis and treatment of low back pain

Article

Full-text available

Jul 2006
Br Med J

Low back pain is a considerable health problem in all developed countries and is most commonly treated in primary healthcare settings. It is usually defined as pain, muscle tension, or stiffness localised below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). The most important symptoms of non-specific low back pain are pain and disability. The diagnostic and therapeutic management of patients with low back pain has long been characterised by considerable variation within and between countries among general practitioners, medical specialists, and other healthcare professionals.1 2 w1 Recently, a large number of randomised clinical trials have been done, systematic reviews have been written, and clinical guidelines have become available. The outlook for evidence based management of low back pain has greatly improved. This review presents the current state of science regarding the diagnosis and treatment of low back pain. We used the Cochrane Library to identify relevant systematic reviews that evaluate the effectiveness of conservative, complementary, and surgical interventions. Medline searches were used to find other relevant systematic reviews on diagnosis and treatment of low back pain, with the keywords “low back pain”, “systematic review”, “meta-analysis”, “diagnosis”, and “treatment”. Our personal files were used for additional references. We also checked available clinical guidelines and used Clinical Evidence as source for clinically relevant information on benefits and harms of treatments.3 4 Most of us will experience at least one episode of low back pain during our life. Reported lifetime prevalence varies from 49% to 70% and point prevalences from 12% to 30% are reported in Western countries.w2 w3 The diagnostic process is mainly focused on the triage of patients with specific or non-specific low back pain. Specific low back pain is defined as symptoms caused by a specific pathophysiological mechanism, such …

The Effect of Dynamic Strength Back Exercise and/or a Home Training Program in 57-year-old Women With Chronic Low Back Pain

Article

Jul 1997

Study design. A prospective, randomized investigation. Objectives. To compare the effect of dynamic strength back muscle training with that of a home training program and to evaluate the long-term effect of the home training program in patients with chronic low back pain. Summary of Background Data. In a health survey of 57-year-old women, those with chronic low back pain were selected using the Nordic Questionnaire. Of 172 women with low back pain, 74 participated in the study. Methods. The participants were randomly assigned to either dynamic strength back exercises at a fitness center and a home training program or to the home training program for the first 3 months, after which both groups continued to pursue the home training program. Follow-up observation was by examination at 3 and 12 months and by mailed questionnaire after 3 years. The primary effect variables were disability, sickleave, and use of health care services. Results. Both training groups manifested significant improvement at the 3- and 12-month follow-up examinations, yet the adherence rate was much better in the group assigned to the fitness center. Those who adhered to the training program for the first year manifested significant improvement according to the 3-year follow-up questionnaire. There was a significant reduction in the number of women on sick-leave and in use of health care services after 1 year, but not after 3 years. Conclusions. The home training program was as effective as the supervised dynamic strength muscle training program and yielded lasting improvement after at least 1 year of adherence. The adherence rate was much better, however, when the training was supervised at the start.

A Rehabilitation Programme for Patients with Chronic Low Back PainA Randomised Controlled Trial

Article

Jul 1993

Helen Frost

Distribution Theory for Glass's Estimator of Effect Size and Related Estimators

Article

Jun 1981

Larry V Hedges

Glass's estimator of effect size, the sample mean difference divided by the sample standard deviation, is studied in the context of an explicit statistical model. The exact distribution of Glass's estimator is obtained and the estimator is shown to have a small sample bias. The minimum variance unbiased estimator is obtained and shown to have uniformly smaller variance than Glass's (biased) estimator. Measurement error is shown to attenuate estimates of effect size and a correction is given. The effects of measurement invalidity are discussed. Expressions for weights that yield the most precise weighted estimate of effect size are also derived.

In Statistical Power Analysis for the Behavior Sciences (Revised Edition)

Book

Jan 1988

Jacob Cohen

The Response of Persons With Chronic Nonspecific Low Back Pain to Three Different Volumes of Periodized Musculoskeletal Rehabilitation

Abstract

No full-text available